We’re taking a brief break from International Breastfeeding and MAINN Conference introductions this week to bring to you a guest post by Master Herbalist, Certified Aromatherapist and Our Milky Way contributor Donna Walls, RN, BSN, IBCLC, ICCE, ANLC.
In many cultures, the placenta is regarded as a sacred, life-giving force even after the birth of the baby it helped sustain. Centuries-old traditions of ceremonial handling of the placenta like its burial, burning and consumption are practiced globally. It wasn’t until the 1970s and 80s that human placentophagy (consumption of the placenta) became increasingly popular in the U.S. for its perceived benefits like treatment of postpartum mood disorders and increased milk production. Walls first encountered placentophagy in the form of placental encapsulation about eight years ago in her professional practice. She had some initial concerns.
“Does the progesterone interfere with early lactation?” she wondered.
Today, Walls and other maternal health care providers remain uncertain of the effects of placentophagy. Because it is “way far out of mainstream medicine,” there is scant research about the practice, Walls predicts.
The placenta acts as a “filter” during pregnancy; should we worry about maternal ingestion of toxins when consuming the placenta? Walls says this isn’t her biggest concern.
“I’m more worried about the lack of standards for preparation,” she says.
Moreover, Walls reports a connection between mothers who have low milk supply and ingestion of placenta in her practice. This week, she shares with us her reflections and findings. With scarce evidence demonstrating either the safety or harm of placentophagy and a growing body of anecdotal evidence, Walls offers: “Nonjudgmental conversations are key.”
Placental Encapsulation: Friend or Foe of Postpartum Mothers?
In recent years a practice has appeared which involves the preparation of a woman’s placenta for ingestion. Preparation practices vary from dehydration to heat treatments. The dried and ground placenta is then placed in capsules for ingestion over the first days or weeks after birth. Some recipes can be found for the use of the placenta for making soups, stews or smoothies to be eaten after the birth. This controversial practice has been cited as a common custom throughout history and often referred to as part of traditional medicinal systems. Many proponents of placental ingestion report the benefits of less postpartum mood disorders, enhanced breastmilk production, treatment of anemia and encouraging uterine involution. Another rationale for ingestion points to the common mammalian practice of eating placentas immediately after the animal gives birth. Most authorities agree that this practice seems to be done for protection of the offspring by removing the smell of blood which can attract predators and not for nutritional needs. This immediate consumption also allows for the normal physiologic function of lactogenesis which occurs after the initial surge of ingested progesterone dissipates quickly over the first hours and days causing increasing levels of prolactin to begin early milk production.
Research supporting the safety and efficacy of placental ingestion, placentophagy, has been scarce as most information is anecdotal. Concerns include possible low milk supply issues and unregulated, unsafe preparation practices resulting in contamination and possible infections. A case of neonatal group B Streptococcus sepsis was recently reported to the CDC. The Centers for Disease Control and Prevention then recommended that the intake of placenta capsules should be avoided owing to inadequate eradication of infectious pathogens during the encapsulation process The Association of Placenta Arts provides guidelines for patients and providers but at this time, there are no regulations for the safety in preparation or storage or standardization of amounts needed for therapeutic effects.
The low milk supply concerns can be explained by the physiology of early lactation. Placental progesterone fills and activates the receptor sites on the alveolar (milk making) cells during the pregnancy and is responsible for colostrum production in the last half of the pregnancy. At birth and with the expulsion of the placenta there is a dramatic, rapid drop in the progesterone allowing the receptor sites to empty of progesterone and fill with prolactin, the hormone responsible for milk production. Prolactin is released when the infant stimulates the nipple during feeding or nipple stimulation occurs with expression of milk.
There is no clear answer to the question of how much of the active hormone remains after the preparation process is completed. If the hormone is degraded, there may not be a negative effect on early milk production. If progesterone remains physiologically active there is a concern. Only one study (Young et al, 2016) found that hormones did remain active and in levels high enough to cause a physiologic response.
In my professional practice, I have found a connection between mothers who have low milk supply and ingestion of placenta. Many of these mothers complained that they never really felt the initial filling, and when they expressed their milk, rarely pumped adequate milk to meet their infant’s needs. They struggled with supply, even after adding extra feedings or expression sessions and often began supplementing when there was poor weight gain in the newborn period. There were enough cases noted that I added a routine question about the practice of placental ingestion to my history when working with mothers who have milk supply concerns. I have also found, within days, there was a filling of the breast and an increase in supply when the placental ingestion was discontinued.
So, how can we respond to patient questions? Should we be adding placental encapsulation education in our consults or prenatal breastfeeding classes? There seems to be enough research to be aware of some concerns regarding milk supply issues. We need to ask, nonjudgmentally, about the possible ingestion of placenta when there are low milk supply concerns. If education is provided either prenatally or post birth, it is helpful to supply all information and research to help our families reach an informed decision and then support their lactation needs with accurate, evidence-based techniques.
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